Validation of the Indian (Hindi) version of the life-space assessment scale among community-dwelling older adults: a multicentric cross-sectional study.

BACKGROUND: The Life-Space Assessment (LSA) is an instrument that measures mobility in older adults as they reach different areas, defined as life-spaces extending from home to beyond towns or regions. The purpose of the study was to develop the Hindi version of the LSA (LSA- H) and to investigate the validity and reliability of the Hindi version as well as its cultural adaptation. METHODS: A cross-sectional study of two hundred forty-five older adults participated in the study from four different study practice areas. Following forward backwards translation, the LSA-H was developed, and the scores were correlated with those of the Activities-Specific Balance Confidence Scale Hindi (ABC- H), the Physical Health Subscale of the WHO-BREF Questionnaire and the Geriatric Depression Scale: Short Form Hindi (GDS-SFH) to test the criterion and concurrent validity. RESULTS: The mean score and standard deviation of the LSA-H questionnaire were 56.53 ± 35.99, those of the Physical Health Subscale of the WHO-BREF instrument were 18.54 ± 7.87, those of the GDS-SFH questionnaire were 6.95 ± 4.21 and those of the ABC- H questionnaire were 54.40 ± 28.96. The Pearson correlation coefficient (r) between the LSA-H score and ABC-H score was 0.707 (p value < 0.0001), that between the LSA-H score and the Physical Health Subscale of the WHO-BREF was 0.766 (p value < 0.0001), and that between the LSA-H score and GDS-SFG score was - 0.674 (p value < 0.0001). CONCLUSION: This study demonstrated that the Hindi version of the LSA is a valid and reliable instrument for assessing living space among older adults in the Hindi language in an Indian population. Furthermore, the LSA-H was significantly correlated with other health assessment tools in terms of functional mobility, general health status and mental well-being.

Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand.

Introduction: Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition. Material and Methods: A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD). Results: Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities. Conclusion: Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.

Cervical Vertebral Maturation Assessment using various Machine Learning techniques on Lateral cephalogram: A systematic literature review.

Importance: For the assessment of optimum treatment timing in dentofacial orthopedics, understanding the growth process is of paramount importance. The evaluation of skeletal maturity based on study of the morphology of the cervical vertebrae has been devised to minimize radiation exposure of a patient due to hand wrist radiography. Cervical vertebral maturation assessment (CVMA) predictions have been examined in the state-of-the-art machine learning techniques in the recent past which require more attention and validation by clinicians and practitioners. Objectives: This paper aimed to answer the question "How are machine learning techniques being employed in studies concerning cervical vertebral maturation assessment using lateral cephalograms?" Method: A systematic search through the available literature was performed for this work based upon the Population, Intervention, Comparison and Outcome (PICO) framework. Data sources study selection data extraction and synthesis: The searches were performed in Ovid Medline, Embase, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR). A search of the grey literature was also performed in Google Scholar and OpenGrey. We also did a hand-searching in the Angle Orthodontist, Journal of Orthodontics and Craniofacial Research, Progress in Orthodontics, and the American Journal of Orthodontics and Dentofacial Orthopedics. References from the included articles were also searched. Main outcomes and measures results: A total of 25 papers which were assessed for full text, and 13 papers were included for the systematic review. The machine learning methods used were scrutinized according to their performance and comparison to human observers/experts. The accuracy of the models ranged between 60 and 90% or above, and satisfactory agreement and correlation with the human observers. Conclusions and relevance: Machine learning models can be used for detection and classification of the cervical vertebrae maturation. In this systematic review (SR), the studies were summarized in terms of ML techniques applied, sample data, age range of sample and conventional method for CVMA, which showed that further studies with a uniform distribution of samples equally in stages of maturation and according to the gender is required for better training of the models in order to generalize the outputs for prolific use to target population.

Cardiovascular Morbidity, Quality of Life, and Cost of Care among Diabetic Patients: A Comparative Study from a Tertiary Care Hospital of Uttarakhand, India.

OBJECTIVES: Diabetes is commonly observed to be associated with several comorbidities, out of which cardiovascular comorbidities are most frequently observed. The present study has been done to estimate the proportion of cardiovascular comorbidities among patients of diabetes and to compare it with that of matched nondiabetics. It also aimed to compare the quality of life (QOL) scores and the cost of treatment between diabetics and nondiabetics with cardiovascular comorbidities. METHODOLOGY: A hospital-based comparative analytical study was conducted in a tertiary care hospital of Uttarakhand, India. One hundred and ninety-five diabetic were compared with an equal number of age- and gender-matched nondiabetics. We compared the two groups for the presence of comorbidities by Chi-square test and for QOL and cost of care by independent t-test. Regression was done to study factors associated with direct cost incurred for treatment among diabetics with cardiovascular comorbidity. RESULTS: The present study reported about four-time higher risk (odds ratio: 3.9; confidence interval: 2.5-6.1) of comorbidities of cardiovascular system (CVS) among diabetics as compared to nondiabetics. QOL scores were reported to be significantly lower among diabetics with comorbidities of CVS in comparison to nondiabetics. Significant predictors of direct cost among diabetics were religion, marital status, income, and use of alcohol. CONCLUSION: Cardiovascular comorbidities have been reported to be four times higher among diabetics in comparison to nondiabetics, leading to an adverse effect on QOL and increased expenditure on treatment.

Effect of comorbidities on direct cost among type 2 diabetes mellitus (T2DM) patients in tertiary care government hospital in Uttarakhand, India: A primary data analysis of out of pocket expenditure.

BACKGROUND AND AIMS: The objective of present study was to estimate and compare the direct cost between diabetics and age and gender matched non-diabetics. It also aimed to estimate and compare the effect of various comorbidities on direct cost between cases and controls, while simultaneously trying to determine the predictors of direct cost among T2DM patients. METHODS: A hospital-based pair matched case-control study was conducted in a tertiary care hospital in Garhwal division of Uttarakhand, India to accomplish the objectives of study. Regression analysis was applied to determine the predictors of direct cost among diabetics. RESULTS: Mean annual direct cost among diabetics was estimated to be US$ 104.6 (Indian Rupees (INR) 7338.9)) in comparison to US$ 27.8 (INR 1905.8) among non-diabetics. The total cost among cases was significantly higher than controls, if they had comorbidities from CVS, nervous, ophthalmic, respiratory and musculoskeletal system. Gender, education, duration of diabetes and number of comorbidities were significant predictors in estimating the direct cost among cases. For each one-year increase in duration of diabetes, direct cost increased by 13.1 unit. CONCLUSIONS: The study provides us conclusive evidence of significantly higher expenditure among diabetics in comparison to non-diabetics. An effect on direct cost among diabetics was observed with types and increasing number of comorbidities.

Sleep quality assessment among college students using Pittsburgh Sleep Quality Index in a municipal corporation area of Uttarakhand, India.

INTRODUCTION: Poor sleep quality have been reported among adults in most countries and are increasingly been reported in their predecessors, the college students. The present study aimed to assess sleep patterns and determine its association with various correlates amongst college students for effective and timely interventions in the habit-forming years of the life. METHODOLOGY: This was a cross sectional study done among college students enrolled in different courses, in Rishikesh municipal corporation area, in Dehradun district of Uttarakhand, India. Sleep Quality was assessed using a validated Pittsburgh Sleep Quality Index (PSQI), which has seven components while Perceived Stress Scale-10 assessed Stress. RESULTS: Poor sleep quality was reported among 66% of respondents. Mean sleep latency among respondents was 27.2 minutes (SD 20.75 min), with a median and mode of 20 minutes and 60 minutes respectively.On logistic regression analysis, yoga/ meditation, which have been recognized as effective relaxation techniques since ages, were found to have a positive association with better sleep quality (OR 0.47, 95% CI (0.26 - 0.84). Stress (OR 4.10, 95% CI 1.71- 9.83) and mobile use before bedtime (OR 1.956, 95% CI: 1.02- 3.75) were also significant predictors of poor sleep quality. CONCLUSIONS AND RECOMMENDATIONS: The prevalence of poor sleep quality was quite high. Relaxation techniques such as yoga/ meditation and stress relieving workshops may pay rich dividends. Use of electronic devices before bedtime need to be restricted for better sleep quality.

A study on assessment of symptoms and functionality in DOTS cured patients in two districts of Garhwal, Uttarakhand.

BACKGROUND: In 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease. India has achieved the target of a case detection rate of 70% and a cure rate of 85% through the nationwide Directly Observed Treatment Short Course (DOTS) strategy. Tuberculosis may generate residual lesions in the course of its pathology, which impair the functionality of the patient even after achieving "cure" or "treatment completion". AIMS: To assess the presence of symptoms and functionality of tuberculosis patients who had completed the treatment or had been declared as cured under Revised National Tuberculosis Programme (RNTCP). METHODS: The present study was a cross sectional study. It was conducted in the two Tuberculosis Units (TUs) of Rudraprayag and Pauri in Garhwal region of Uttarakhand among the people who had completed treatment under DOTS or had been declared as cured under RNTCP in last one year. RESULTS: Even at the completion of the treatment about 37% had cough, 25% had expectoration, 6% had hemoptysis, more than 50% had chest pain and 65% had breathlessness. The mean distance walked by the participants in six minutes was 363.5 ± 58.2 m with a range of 245-490 m. CONCLUSIONS: The persistence of symptoms indicate that the functionality of DOTS cured patients remains compromised even after days and months of treatment completion, thereby necessitating measures for the improvement of the overall health of the patients rather than just the microbiological cure.

Client satisfaction with immunization services in urban slums of Lucknow district.

OBJECTIVE: To assess the satisfaction of parents with the immunization services and its association with their sociodemographic characteristics. METHODS: The study was a part of the coverage evaluation survey conducted using the WHO 30 cluster sampling methodology in the Urban slums of Lucknow district, north India. Analysis for a total of 388 respondents of completely or partially immunized children, was done to assess the level of satisfaction and its determinants. RESULTS: The overall satisfaction was more than 90% in the respondents of both the categories of the children, however the difference between the satisfaction rates was found to be significant. Also the satisfaction with accessibility (p<0.04) and information given by the health worker (p<0.00) differed significantly between completely and partially immunized. Most of the sociodemographic factors were not found to have a significant association with the satisfaction related to different parameters of the immunization services. CONCLUSION: The dissatisfaction regarding the various aspects of immunization services emphasizes the imperative need to take urgent intervention, for the achievement of goal of universal immunization.